Return on Investment Calculators: Development, Considerations, and Limitations

Medication Therapy Management (MTM) has been shown to improve patient outcomes, increase patient adherence to established guidelines, and increase patient adherence to medication. Unfortunately, cost-benefit analysis of MTM programs have been minimal, and studies which have examined the economic effects of MTM have had limited sample sizes and quasi-experimental study designs. Thus, the degree to which results are generalizable to other populations is uncertain. Though the lack of economic data regarding MTM is sparse, MTM has become a topic of national interest as evidenced by its inclusion into Medicare Part D. Additionally, many employers are drawn to the prospect of using MTM to reduce or stabilize healthcare spending for employees. In response to the growing interest in the potential long-term benefits of MTM, a number of models have emerged that seek to quantify the expected economic impact of implementing MTM programs. One approach to modeling such outcomes is the creation of a Return on Investment (ROI) calculator. ROI calculators provide a practical benefit above and beyond traditional analyses. First, they consolidate a body of scientific literature, making it more manageable to work with than in its raw form. Second, they create a way in which to make scientific literature accessible to the non-scientific community. This format may be particularly useful to benefits managers interested in offering such programs to employees but requiring evidence for potential-cost savings. Third, ROI calculators allow for flexibility of calculations, as employers can estimate their expected savings in a specific population instead of applying a single model for the overall population. While the creation of these tools is certainly beneficial for showing the potential impact of such programs, there are a number of assumptions and limitations that must be considered when creating and using such a tool. This paper will consider both the use and construction of ROI calculators in order to enable more thoughtful, scientifically rigorous, and generalizable ROI calculator creation that is applicable to various patient populations of interest. Discussion will first involve how to focus ROI calculations to the appropriate disease state, MTM intervention, and expected outcome(s). Specific topics to address will include: reconciling conflicting results in scientific literature, using international studies to determine economic impact, generalizability of published studies to the target population, determining costs to employers, and tailoring the tool for use in instances where supplementary data is available. Useful assumptions and their potential impact are also addressed.